Veteran’s application and appeal denied

Editor’s Note: This is a second story in a series of three articles about a local veteran’s efforts to be re-admitted to IVH.

In May, while witnessing friend Daniel A. “Tony” Casali’s physical and mental health deteriorate significantly, Dick Schrad worked to help get Casali be re-admitted to the Iowa Veterans Home.

To Schrad, Casali, 62, was not just a friend, but a fellow veteran in dire need of care.

Schrad is a Marshalltown resident who retired from IVH after 30 years

With a graduate degree in social work, he applied knowledge and on the job experience to help IVH residents and veterans in Central Iowa with a myriad of problems.

Re-application

Schrad thought Casali’s extensive physical and mental health issues would qualify for re-admission based on IVH criteria he knew well.

He believed Casali was sufficiently disabled by physical and mental health diseases – a total of 24 major diagnosis – and met guidelines for re-admittance.

He was incorrect – Casali’s application was denied later in May.

Schrad discussed the denial with IVH admission staff.

They told him they could not ascertain all of Casali’s problems from his application, and that Schrad was a better historian.

He was told he could help Casali with an appeal, which had to be submitted within 30 days.

To Schrad, the rejection of Casali’s application re-enforced his belief IVH was allegedly continuing former Commandant David Worley’s systematic reduction in services to younger veterans begun in 2011, when Worley discharged 42 younger veterans upon orders from Dr. Jim Burris of the Veterans Administration, Casali among them.

(However, their discharge was upheld by the State of Iowa Ombudsmen).

Schrad made serious allegations against Worley, writing: “He (Worley) then proposed legislation to make it much more difficult for younger veterans to be admitted.

Schrad also alleged IVH was focusing on older veterans for admission because of a higher rate of reimbursement from federal sources, a claim rebutted by Commandant Jodi Tymeson.

Schrad wrote: “Analysis of what has occurred suggests it (admission procedures) was about the money. Older veterans are eligible for Title 19, along with many other benefits and federal funding. The IVH receives 100 percent reimbursement from Title 19 for all eligible residents. The plan became simple: Get rid of younger veterans and keep their numbers reduced; cut expenses by reducing or eliminating entirely activities and services that once made IVH stand out; reduce staff till it becomes like any other nursing home; and do anything possible to reduce the influence of the union. Power became consolidated and people feared losing their home or their job if they complained or disagreed. Money flowed in like never before and was sent to Des Moines.”

Commandant Tymeson’s rebuttal

Tymeson, an Ogden native, recently celebrated her third anniversary being appointed commandant by Gov. Terry Branstad.

She is a retired Brigadier General from the Iowa National Guard with 33-years service.

Prior to being appointed as IVH’s Chief Operating Officer in 2013, by Governor Branstad, she had extensive leadership positions while serving on a number of veterans commissions.

Tymeson also served several terms in the Iowa Legislature representing the Boone area.

She said federal Health Information Privacy Protection Act regulations prohibited her from discussing details of Casali’s application and appeal in detail.

“I can speak in general,” she said, and defended IVH admission guidelines.

“I appreciate everyone advocating for veterans and Iowans with mental health issues,” she said. “I do believe it should be an area of focus. However, our requirement is to follow all the laws and regulations pertaining to IVH. We have a detailed application process, and a screening to certify the level of care an applicant would need.”

She said IVH staff conscientiously evaluate each application on its own merits, regardless if they lived at IVH previously.

Additionally, IVH staff evaluate if the applicant can live on their own, with support from numerous entities at the local, state, or federal level.

They range from mental health to nursing and in-home care to Meals-On-Wheels.

Tymeson said regulations require she and staff periodically discuss with residents their ability to live elsewhere using community supports.

“We offer a great place to live,” Tymeson said. “We are required by law and regulation to certify the applicant needs our level of care. “We spend a lot of time … we sometimes will make a visit to the person’s residence to further evaluate … sometimes letters and forms can’t tell you the whole story … so that onsite visit is valuable.”

Appeal

Schrad immediately began working on Casali’s appeal and filed it in June.

He secured what he thought were compelling letters of support from a VA doctor as well as Patricia Kline, a VA social worker. Additionally there were letters from Jasper County Nursing and In-Home Health Services, and Center Associates – all providing services to Casali.

Wrote Kline: “Mr. Casali has been involved in this social worker’s case management services for homeless veterans for the past two and a half years.

“Mr. Casali has had numerous problems over time that only seem to be getting worse instead of better. Mr. Casali had been homeless due to making a move suddenly (in the summer of 2014) and briefly to Tennessee. Mr. Casali returned to Iowa after he was assaulted and sustained a head injury from one of his relatives there. Since returning from Tennessee, Mr. Casali has managed, with many services, to survive on his own in an apartment in Newton, since fall 2014. Unfortunately, Mr. Casali’s health has been declining. Mr. Casali has had several visits to the emergency room the past two years, and has been admitted to the hospital for several days due to stomach problems (December 2014). Mr. Casali has home health services handle his medications and more recently, has had homemaker services for housekeeping since he finds it more and more difficult to manage his housekeeping due to his health problems. I am currently providing various case management services to Mr. Casali and find that, over time, Mr. Casali is needing more assistance to help him organize and read his mail, help him make and keep appointments, assist him in making sure that he has adequate food and income resources, etc. Again, all these service needs are increasing over time. A close friend has to assist Mr. Casali pay his bills or they may not get paid. Of considerable concern, Mr. Casali has memory problems that create more difficulty for him.”

As part of the appeal process, four IVH staff – including the director of IVH admissions, a mental health nurse, a male nurse and a dormitory social worker, were dispatched to see Casali in his Newton apartment.

Appeal denied

After review, Casali’s appeal was denied.

In a June 17 letter Tymeson wrote: “After carefully reviewing all the information presented to me by our Admissions Committee, I am affirming the original decision of denial for placement at the Iowa Veterans Home. At the present time, you do not meet the criteria for Residential level of care at the Iowa Veterans Home. You also do not meet the criteria for Nursing level of care.

It is our recommendation that you continue to work with Patricia Kline, VA Social Worker, to assist you with any needed community services.”

Tymeson said IVH must certify to its payment sources that the person (applicant) needs either residential or nursing level of care.

“It is not about the payment,” Tymeson said. “For us, it is not about how a person’s care is paid for, but we have to certify to whoever the payment source is that they are in need of that level of care.”